Page 3 - Success Academy | 21-22 Benefits Summary

2021-2022 Benefits Summary
We are pleased to share with you the summary of Success Academy benefits for the 2021-22 year. All full-time employees are eligible for health and welfare benefits beginning on their first day of work and can enroll within the first 30 days of employment. Employees can only make changes to most elections during Annual Benefits Open Enrollment in late May. Benefits will be effective July 1, or within 30 days of a qualifying life event, such as a marriage, the birth of a baby, or a loss of coverage, effective the date of the life event.
Upon separation from Success Academy, health coverage ends on the last day of the month.
Monthly Health Plan Costs*
Medical Plans
Copay Value Plan
Dental HMO Plan
Vision Basic Plan
* Domestic Partners: Employees adding Domestic Partners or Domestic Partners' Child(ren) will be subject to imputed income.
$214.42 Employee Only $592.14 Employee + Spouse $429.42 Employee + Child(ren) $863.44 Employee + Family
1
$107.17 Employee Only $282.82 Employee + Spouse $185.05 Employee + Child(ren) $442.94 Employee + Family
HSA Plan
$130.53 Employee Only $366.79 Employee + Spouse $214.65 Employee + Child(ren) $561.99 Employee + Family
Copay Plus Plan
Dental Plans
$2 Employee Only
$7 Employee + Spouse $4 Employee + Child(ren) $10 Employee + Family
Dental PPO Plan
$8 Employee Only
$26 Employee + Spouse $14 Employee + Child(ren) $36 Employee + Family
Vision Plans
$2 Employee Only
$4 Employee + Spouse $4 Employee + Child(ren) $6 Employee + Family
Vision Plus Plan
$8 Employee Only
$14 Employee + Spouse $14 Employee + Child(ren) $22 Employee + Family